Wednesday, May 30, 2012

Long before any theoretical contributions from various schools of psychoanalysis are introduced to first year candidates at the Tampa Bay Institute for Psychoanalytic Studies, the majority of the first year course, Introduction to Psychoanalytic Concepts I, discusses with candidates how to be with patients. How fortuitous that I have recently come across the immensely readable (and highly autobiographical) primer by Louis Breger, Psychotherapy Lives Intersecting (2012; Transaction Publishers, New Brunswick, NJ) which adds the perspective of former patients, what they found helpful and unhelpful in their treatments, to the pearls gleaned from his vast experience as a psychoanalyst. Breger aims his book at people considering therapy, but therapists, too, will greatly benefit from this jargon free exposition. What is unique about this book is that the many clinical vignettes are enriched by reflections from patients about their own psychoanalytic journeys, something the reader may find courageous.

Elizabeth (pp. ix) writes, 'Throughout the therapy experience with you, I always felt like a person in a relationship, rather than a person to be understood by you, and then explained back to me…you communicated an utter lack of judgment, an acceptance of the aspects of my life about which I was most embarrassed, and modeled that Not Knowing was okay'. Another patient, Bernie, (pp. 29) “singles out catharsis, having a safe person to talk with, and insights-in that order-as the helpful factors of his therapy.” Breger says of his own analysis, “…it was the relationship itself—being accepted, listened to in a noncritical manner, understood, appreciated, even liked—after revealing what I felt were my most shameful and guilt-ridden secrets—that was most helpful." Breger listened closely, was not dogmatic, and did not dictate rules.

Just as research shows that the person of the analyst is more important than her/his theoretical orientation, Breger recognizes that relationship is as important, maybe more so, as interpretation and insight. Breger also sees the benefit of ‘fit’ between analyst and analysand, including whether the therapist likes and identifies with the patient. Instead of illustrating how to behave as an analyst, Breger writes about an analytic attitude. Breger muses on anonymity, authenticity (about being human), self disclosure (must [also] be for the benefit of the patient), and analyzability. But Psychotherapy Lives Intersecting is as much about Breger’s personal journey as an analyst as it is about how his patients viewed their treatment. The neophyte will benefit greatly from this disclosure. His “straightforward approach” to writing and to his patients is refreshing. As a traditionally trained analyst who also found a relational home in contemporary theories, I found it wonderful to immerse myself in a book where I found like mindedness.

Monday, May 14, 2012

While I advocate in analytic treatments for openness and authenticity, I was surprised that Henry A Crumpton, whose book The Art of Intelligence: Lessons from a Life in the CIA's Clandestine Service which came out today, stated some things that good spies have in common with therapists, namely "an intense intellectual curiosity; willingness to deal with ambivalent situations [by which I took he meant ambiguity]; and a certain degree of creativity." Part of me shudders. Still, I like to see our work as therapists as one of collaboration, where both parties strive, by the very nature of their relationship, toward a common purpose, not enemies except in moments of rupture, not out to deceive the other except in protection of the sense of self coupled with a longing to be known and understood. Therapy is a tricky business, no precious metals to be acquired, no missile heads to be dismantled, no foreign dignitaries to be protected, but sometimes a sense of life or death for a particular self state or relationship, an urgency to find one another in the tumult of the outside world, and a hope that we each will sleep more peacefully tonight.

Sunday, May 13, 2012

Winnicott said that the good enough mother never asks the infant to answer of itself the question about the transitional object ‘did I find it or did I create it?’ I also think the good enough mother welcomes and enjoys her infant, sharing the joy of its developing experiences, accepting and loving it, most times, just for its being born, and making quick repair when she doesn’t. But the greatest gift a mother gives her child is her own genuine happiness, a consequence of her own subjectivity and interests, her own feeling of being loved and accepted in the world. This gift gives children the license to be happy themselves, permission for their own subjectivity, hope for the future (of aging), as well as infuses them with the belief that they are enjoyed, welcomed, and contribute to parental happiness. Jessica Benjamin noted that the subjectivity of the analyst also relieves the patient of having to feel responsible for the analyst’s ‘happiness.’
A Happy Mother’s Day to all the moms out there.

Tuesday, May 8, 2012

Maurice Sendak, acclaimed children’s book illustrator and author, died today a few weeks shy of his 84th birthday. His most famous book Where the Wild Things Are, a Caldecott Medal winner, is also beloved to psychoanalysts because it lends itself beautifully to metaphors about the unconscious life and about therapy. We pledge to open ourselves to the scary and the wild in our patients and in our selves, and to go with them to places where others are not allowed or fear to tread. His illustrations of monsters are personal to Sendak (not griffins or gorillas) derived from his childhood experiences with all his Jewish relatives with “big warts and hairs growing out of their noses,” adults who “treated them in silly fashion” as kids constrained in best clothes awaiting dinner and having to “listen to their tedious conversation” as well as having been told he and his siblings had gotten big or fat and they would “eat us up.” The monsters tell Max: Please don’t go, we’ll eat you up, we love you so. [Sendak lamented that book signings unwittingly turned him into a strange monster to the children shoved at him to autograph (write in their books, an action forbidden to them) and whom they imagined wanted to take, keep, as well as defile their favorite book.
Sendak said, “A child was a creature without power, …pocket money or escape routes of any kind.” He detested Peter Pan because he could not conceive that any child would want to remain a child, powerless. He thought “all kids would like to have control” And Max, the king of all wild things, was lonely and wanted to be where someone loved him best of all. Max not afraid of the montsters and so child readers likewise were not afraid.
Sendak’s own fears included the vacuum cleaner and The Invisible Man, a movie which he credited for his lifelong insomnia. He found “terrifying” the unraveled bandages (of head) exposing nothing there. Big events in his childhood were “being sick” and “being expected to die” (discussed in front of children by his parents) which “pervaded my soul apparently.” In the days before antibiotics and vaccines, Sendak spent lot of time, sick, in bed with childhood illnesses. When sick, before TV, Sendak spent a lot of time looking out windows, happy memories which appeared in his books. His father left Eastern Europe before the Holocaust but all father’s relatives perished there and father grief stricken all Sendak’s life.
In the Night Kitchen was banned in some libraries across the USA because its protagonist Mickey appears nude. Sendak said of this that he was “not out to cause a scandal”… “I assumed everyone knew little boys had that.” Outside Over There is about sibling rivalry and responsibility; Ida is left to babysit her baby sister, who is kidnapped by goblins, and Ida must come to terms with her ambivalent feelings as she goes on a magical adventure to rescue her sister. Among other awards, Sendak also received a Newbery Award for his illustration of Isaac Bashevis Singer’s children’s story Zlateh the Goat. Sendak’s family moved a lot due to money problems growing up in Brooklyn. He also wrote a book about homelessness We Are All in the Dumps with Jack and Guy: Two Nursery Rhymes with Pictures.

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Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studiesor, as it is conveniently known, T-BIPS. We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens. We look forward to a spirited dialogue with you.Lycia Alexander-Guerra, M.D.TBIPS PresidentGabcast! Welcome! #3

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About TBIPS

In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.